Vocational assessment and rehabilitation after acquired brain injury

Transcription

1 Vocational assessment and rehabilitation after acquired brain injury Inter-agency guidelines BSRM British Society of Rehabilitation Medicine Part of the Department for Work and Pensions Royal College of Physicians The guidelines were prepared by the Inter-agency Advisory Group on Vocational Rehabilitation after Brain Injury, and drafted and edited by Dr Andy Tyerman and Mr Mick Meehan. They were developed in association with the British Society of Rehabilitation Medicine Working Party on Rehabilitation following Acquired Brain Injury, chaired by Professor Lynne Turner-Stokes. The guidelines are published in collaboration with the Clinical Effectiveness and Evaluation Unit, Royal College of Physicians 2004

2 Acknowledgements These Guidelines have been funded by grants from the Department of Health, the Department for Work and Pensions, and the British Society of Rehabilitation Medicine. We wish to thank members of the Inter-agency Advisory Group (see Appendix 1A) for their invaluable contribution to the development of the Guidelines and, where appropriate, their host organisations for supporting their involvement and their colleagues for supplying additional information. We would also like to thank members of the Placement Support Group of the Working Out programme, Headway, members of Jobcentre Plus Brain Injury Work Psychology Regional Leads Group and others individuals (listed in Appendix 1A) for their comments on drafts of the Guidelines. AT, MM BRITISH SOCIETY OF REHABILITATION MEDICINE c/o Royal College of Physicians 11 St Andrews Place, London NW1 4LE Registered charity No JOBCENTRE PLUS ROYAL COLLEGE OF PHYSICIANS 11 St Andrews Place, London NW1 4LE Registered charity No Copyright 2004 Royal College of Physicians of London ISBN Typeset by Dan-Set Graphics, Telford, Shropshire Printed in Great Britain by The Lavenham Press, Suffolk ii

3 The British Society of Rehabilitation Medicine The British Society of Rehabilitation Medicine is the UK professional organisation for practitioners in rehabilitation medicine. It is a young, vibrant organisation devoted to: promoting the development and good practice of rehabilitation medicine as a medical specialty enhancing undergraduate and postgraduate education in rehabilitation and disability issues supporting rehabilitation research working with related medical, paramedical and voluntary organisations to further these aims. Membership is open to registered medical practitioners with an interest in disability and its management. Department for Work and Pensions Jobcentre Plus Jobcentre Plus is an executive agency of the Department for Work and Pensions (DWP). Launched in April 2002, Jobcentre Plus brought together the Employment Service and parts of the Benefits Agency that delivered services to working age people. Our aim is to help more people into work and more employers fill their vacancies, and to provide people of working age with the help and support to which they are entitled. The Department for Work and Pensions was created in June 2001 to promote opportunity and independence for all. The Department for Work and Pensions objectives are to: ensure the best start for all children and end child poverty in 20 years promote work as the best form of welfare for people of working age, whilst protecting the position of those in greatest need combat poverty and promote security and independence in retirement for today s and tomorrow s pensioners improve rights and opportunities for disabled people in a fair and inclusive society modernise welfare delivery so as to improve the accessibility, accuracy and value for money of services to customers, including employers. Jobcentre Plus plays a vital role in helping to deliver the Department s objectives. Working with a range of partners, Jobcentre Plus promotes work as the best form of welfare, helping unemployed and economically inactive people of working age move closer to the labour market and compete effectively for work, while providing appropriate help and support for those without work. The key objectives of Jobcentre Plus are to: increase the effective labour supply by helping as many unemployed and economically inactive people of working age as possible to move into jobs or self-employment and active competition for jobs by making available to them job vacancies, information, advice, training and support and encouraging employers to open up more opportunities to them provide high quality and demand-led services to employers, which help them to fill job vacancies quickly and effectively with well-prepared and motivated employees iii

4 Vocational assessment and rehabilitation after acquired brain injury help people of working age in the most disadvantaged groups and areas to move closer to the labour market, compete effectively for, and remain in work and to adjust more quickly to economic change work towards parity of outcomes for minority ethnic customers ensure that people receiving working age benefits fulfil their responsibilities and are offered high quality help and support appropriate to their needs, while protecting the position of those in greatest need pay people of working age the correct amount of benefit to which they are entitled, at the right time and throughout the period of their claim, and to protect the benefit system from fraud, error and abuse improve continuously the quality, accessibility and delivery of services to all working age customers, regardless of ethnicity, gender, age or disability and achieve the best possible outcome for each of them increase Jobcentre Plus overall productivity, efficiency and effectiveness. The Clinical Effectiveness and Evaluation Unit (CEEU) The Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians concentrates on those issues that are at the centre of the national healthcare agenda, eg the National Service Frameworks in Cardiology, Care of Older People and Diabetes, and the Calman-Hine Cancer Framework, as a continuous programme of work rather than multiple one-off projects. Associate Directors, who are active clinicians in their field, lead the relevant programmes in conjunction with the Director. The CEEU has expertise in the development of guidelines, the organising and reporting of multi-centre comparative audit to encourage guideline implementation, and studies on how the outcome of care can be measured reliably. All our work is collaborative with relevant specialist societies, patient groups and health service bodies such as the National Service Frameworks, National Institute for Clinical Excellence and the Commission for Health Audit and Inspection. The CEEU is self-financing with funding coming from government, charities and other organisations. The Royal College of Physicians of London The Royal College of Physicians aims to promote the highest standards of medical practice in order to improve health and healthcare. To achieve this it seeks to: set and improve standards for clinical practice support physicians in their practice of medicine promote and provide continuing professional development throughout a doctor s career advise the government, the public and the profession on healthcare issues. It defines and monitors programmes of education and training for physicians, and sets examinations including the MRCP(UK) qualification required of UK graduates before they can enter specialist training. It has over 11,000 Fellows worldwide. iv

7 Executive summary Introduction Return to employment or alternative occupation is a primary goal and a critical factor in the restoration of quality of life for people with acquired brain injury. Currently, many people with acquired brain injury are unable to access, return to or remain in previous or alternative employment. This has major economic implications as well as far-reaching consequences for the individual and their family. Those unable to return to paid employment are often not provided with the advice, opportunity and support to enable them to find alternative occupation appropriate to their needs. There is, however, consistent evidence that specialist vocational rehabilitation services assist people with acquired brain injury in securing sustainable employment or alternative occupation. An Inter-Agency Advisory Group on Vocational Rehabilitation after Brain Injury was formed in April 2003, comprising members of the NHS, Jobcentre Plus, social services and independent vocational providers. The group was set up initially to recommend guidelines on vocational assessment and rehabilitation to a working party convened by the British Society of Rehabilitation Medicine, which was developing national clinical guidelines on rehabilitation following acquired brain injury. 1 The Advisory Group agreed that there was a wider need to produce detailed guidelines and an inter-agency framework on vocational assessment and rehabilitation after brain injury across the NHS, Jobcentre Plus, social services and independent vocational providers. It was agreed that staff in these agencies need guidance in working together to facilitate access to appropriate existing services for people with brain injury. The inter-agency guidelines and framework focus on traumatic brain injury, for which there is a substantial research base, but are relevant to other forms of acquired brain injury. Inter-agency guidelines and framework The inter-agency guidelines and framework include the following background material: an introduction including definitions of key terms (Section 1); a summary of vocational outcome and specialist brain injury vocational rehabilitation (Section 2); a review of NHS brain injury provision (Section 3); occupational health services (Section 4); Jobcentre Plus services (Section 5); and other occupational/educational provision (Section 6). This is followed by a recommended framework for joint working across agencies (Section 7), and detailed guidelines (Section 8) for the following provision: return to previous employment, education or training (paras 8.1 9) vocational/employment assessment (paras ) vocational rehabilitation (including Work Preparation programmes) (paras ) WORKSTEP (supported employment) (paras ) occupational/educational provision (paras ). vii

8 Vocational assessment and rehabilitation after acquired brain injury There is good evidence for the effectiveness and cost benefit of vocational rehabilitation in adults with acquired brain injury but none to underpin the specific recommendations given in this document. These are therefore graded at level C (see Appendix 1B). The recommendations reflect the collective expert opinion of the Advisory Group who have substantial direct experience in this field of practice. Implementation In the suggestions for implementation (Section 9), key recommendations are that staff from local NHS brain injury services, Jobcentre Plus, local councils and independent vocational, occupational and educational providers: undertake a joint review of services for people with brain injury and develop local protocols, drawing on these inter-agency guidelines and framework, both to assist staff in working together to facilitate appropriate and timely access to current services and also to identify gaps in local service provision establish ongoing service links (eg between brain injury neuropsychologist, occupational therapist, Jobcentre Plus disability employment advisor and work psychologist) to discuss the vocational needs of individuals with brain injury adopt a joint approach both to increasing awareness of vocational needs and to the development of specialist skills training for all providers of vocational assessment and rehabilitation services for people with brain injury. It is hoped that the proposed inter-agency guidelines and framework will assist agencies and their staff in making best use of available provision. However, it is clear that the current underdeveloped NHS provision of brain injury services, the shortage of specialist brain injury vocational rehabilitation programmes and suitable occupational/educational provision, and lack of joint working across agencies, all mean that many people with brain injury do not currently have the opportunity to achieve their optimal occupational outcome. The National Service Framework for Long-Term Conditions provides an ideal opportunity to review provision of services to meet the complex occupational needs of people with acquired brain injury. Reference 1 Royal College of Physicians and British Society of Rehabilitation Medicine. Rehabilitation following acquired brain injury: national clinical guidelines (Turner-Stokes L, ed). London: RCP, BSRM, viii

9 Vocational assessment and rehabilitation after acquired brain injury Inter-agency guidelines BSRM British Society of Rehabilitation Medicine Part of the Department for Work and Pensions Royal College of Physicians The guidelines were prepared by the Inter-agency Advisory Group on Vocational Rehabilitation after Brain Injury, and drafted and edited by Dr Andy Tyerman and Mr Mick Meehan. They were developed in association with the British Society of Rehabilitation Medicine Working Party on Rehabilitation following Acquired Brain Injury, chaired by Professor Lynne Turner-Stokes. The guidelines are published in collaboration with the Clinical Effectiveness and Evaluation Unit, Royal College of Physicians 2004

10 Acknowledgements These Guidelines have been funded by grants from the Department of Health, the Department for Work and Pensions, and the British Society of Rehabilitation Medicine. We wish to thank members of the Inter-agency Advisory Group (see Appendix 1A) for their invaluable contribution to the development of the Guidelines and, where appropriate, their host organisations for supporting their involvement and their colleagues for supplying additional information. We would also like to thank members of the Placement Support Group of the Working Out programme, Headway, members of Jobcentre Plus Brain Injury Work Psychology Regional Leads Group and others individuals (listed in Appendix 1A) for their comments on drafts of the Guidelines. AT, MM BRITISH SOCIETY OF REHABILITATION MEDICINE c/o Royal College of Physicians 11 St Andrews Place, London NW1 4LE Registered charity No JOBCENTRE PLUS ROYAL COLLEGE OF PHYSICIANS 11 St Andrews Place, London NW1 4LE Registered charity No Copyright 2004 Royal College of Physicians of London ISBN Typeset by Dan-Set Graphics, Telford, Shropshire Printed in Great Britain by The Lavenham Press, Suffolk ii

11 The British Society of Rehabilitation Medicine The British Society of Rehabilitation Medicine is the UK professional organisation for practitioners in rehabilitation medicine. It is a young, vibrant organisation devoted to: promoting the development and good practice of rehabilitation medicine as a medical specialty enhancing undergraduate and postgraduate education in rehabilitation and disability issues supporting rehabilitation research working with related medical, paramedical and voluntary organisations to further these aims. Membership is open to registered medical practitioners with an interest in disability and its management. Department for Work and Pensions Jobcentre Plus Jobcentre Plus is an executive agency of the Department for Work and Pensions (DWP). Launched in April 2002, Jobcentre Plus brought together the Employment Service and parts of the Benefits Agency that delivered services to working age people. Our aim is to help more people into work and more employers fill their vacancies, and to provide people of working age with the help and support to which they are entitled. The Department for Work and Pensions was created in June 2001 to promote opportunity and independence for all. The Department for Work and Pensions objectives are to: ensure the best start for all children and end child poverty in 20 years promote work as the best form of welfare for people of working age, whilst protecting the position of those in greatest need combat poverty and promote security and independence in retirement for today s and tomorrow s pensioners improve rights and opportunities for disabled people in a fair and inclusive society modernise welfare delivery so as to improve the accessibility, accuracy and value for money of services to customers, including employers. Jobcentre Plus plays a vital role in helping to deliver the Department s objectives. Working with a range of partners, Jobcentre Plus promotes work as the best form of welfare, helping unemployed and economically inactive people of working age move closer to the labour market and compete effectively for work, while providing appropriate help and support for those without work. The key objectives of Jobcentre Plus are to: increase the effective labour supply by helping as many unemployed and economically inactive people of working age as possible to move into jobs or self-employment and active competition for jobs by making available to them job vacancies, information, advice, training and support and encouraging employers to open up more opportunities to them provide high quality and demand-led services to employers, which help them to fill job vacancies quickly and effectively with well-prepared and motivated employees iii

12 Vocational assessment and rehabilitation after acquired brain injury help people of working age in the most disadvantaged groups and areas to move closer to the labour market, compete effectively for, and remain in work and to adjust more quickly to economic change work towards parity of outcomes for minority ethnic customers ensure that people receiving working age benefits fulfil their responsibilities and are offered high quality help and support appropriate to their needs, while protecting the position of those in greatest need pay people of working age the correct amount of benefit to which they are entitled, at the right time and throughout the period of their claim, and to protect the benefit system from fraud, error and abuse improve continuously the quality, accessibility and delivery of services to all working age customers, regardless of ethnicity, gender, age or disability and achieve the best possible outcome for each of them increase Jobcentre Plus overall productivity, efficiency and effectiveness. The Clinical Effectiveness and Evaluation Unit (CEEU) The Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians concentrates on those issues that are at the centre of the national healthcare agenda, eg the National Service Frameworks in Cardiology, Care of Older People and Diabetes, and the Calman-Hine Cancer Framework, as a continuous programme of work rather than multiple one-off projects. Associate Directors, who are active clinicians in their field, lead the relevant programmes in conjunction with the Director. The CEEU has expertise in the development of guidelines, the organising and reporting of multi-centre comparative audit to encourage guideline implementation, and studies on how the outcome of care can be measured reliably. All our work is collaborative with relevant specialist societies, patient groups and health service bodies such as the National Service Frameworks, National Institute for Clinical Excellence and the Commission for Health Audit and Inspection. The CEEU is self-financing with funding coming from government, charities and other organisations. The Royal College of Physicians of London The Royal College of Physicians aims to promote the highest standards of medical practice in order to improve health and healthcare. To achieve this it seeks to: set and improve standards for clinical practice support physicians in their practice of medicine promote and provide continuing professional development throughout a doctor s career advise the government, the public and the profession on healthcare issues. It defines and monitors programmes of education and training for physicians, and sets examinations including the MRCP(UK) qualification required of UK graduates before they can enter specialist training. It has over 11,000 Fellows worldwide. iv

15 Executive summary Introduction Return to employment or alternative occupation is a primary goal and a critical factor in the restoration of quality of life for people with acquired brain injury. Currently, many people with acquired brain injury are unable to access, return to or remain in previous or alternative employment. This has major economic implications as well as far-reaching consequences for the individual and their family. Those unable to return to paid employment are often not provided with the advice, opportunity and support to enable them to find alternative occupation appropriate to their needs. There is, however, consistent evidence that specialist vocational rehabilitation services assist people with acquired brain injury in securing sustainable employment or alternative occupation. An Inter-Agency Advisory Group on Vocational Rehabilitation after Brain Injury was formed in April 2003, comprising members of the NHS, Jobcentre Plus, social services and independent vocational providers. The group was set up initially to recommend guidelines on vocational assessment and rehabilitation to a working party convened by the British Society of Rehabilitation Medicine, which was developing national clinical guidelines on rehabilitation following acquired brain injury. 1 The Advisory Group agreed that there was a wider need to produce detailed guidelines and an inter-agency framework on vocational assessment and rehabilitation after brain injury across the NHS, Jobcentre Plus, social services and independent vocational providers. It was agreed that staff in these agencies need guidance in working together to facilitate access to appropriate existing services for people with brain injury. The inter-agency guidelines and framework focus on traumatic brain injury, for which there is a substantial research base, but are relevant to other forms of acquired brain injury. Inter-agency guidelines and framework The inter-agency guidelines and framework include the following background material: an introduction including definitions of key terms (Section 1); a summary of vocational outcome and specialist brain injury vocational rehabilitation (Section 2); a review of NHS brain injury provision (Section 3); occupational health services (Section 4); Jobcentre Plus services (Section 5); and other occupational/educational provision (Section 6). This is followed by a recommended framework for joint working across agencies (Section 7), and detailed guidelines (Section 8) for the following provision: return to previous employment, education or training (paras 8.1 9) vocational/employment assessment (paras ) vocational rehabilitation (including Work Preparation programmes) (paras ) WORKSTEP (supported employment) (paras ) occupational/educational provision (paras ). vii

16 Vocational assessment and rehabilitation after acquired brain injury There is good evidence for the effectiveness and cost benefit of vocational rehabilitation in adults with acquired brain injury but none to underpin the specific recommendations given in this document. These are therefore graded at level C (see Appendix 1B). The recommendations reflect the collective expert opinion of the Advisory Group who have substantial direct experience in this field of practice. Implementation In the suggestions for implementation (Section 9), key recommendations are that staff from local NHS brain injury services, Jobcentre Plus, local councils and independent vocational, occupational and educational providers: undertake a joint review of services for people with brain injury and develop local protocols, drawing on these inter-agency guidelines and framework, both to assist staff in working together to facilitate appropriate and timely access to current services and also to identify gaps in local service provision establish ongoing service links (eg between brain injury neuropsychologist, occupational therapist, Jobcentre Plus disability employment advisor and work psychologist) to discuss the vocational needs of individuals with brain injury adopt a joint approach both to increasing awareness of vocational needs and to the development of specialist skills training for all providers of vocational assessment and rehabilitation services for people with brain injury. It is hoped that the proposed inter-agency guidelines and framework will assist agencies and their staff in making best use of available provision. However, it is clear that the current underdeveloped NHS provision of brain injury services, the shortage of specialist brain injury vocational rehabilitation programmes and suitable occupational/educational provision, and lack of joint working across agencies, all mean that many people with brain injury do not currently have the opportunity to achieve their optimal occupational outcome. The National Service Framework for Long-Term Conditions provides an ideal opportunity to review provision of services to meet the complex occupational needs of people with acquired brain injury. Reference 1 Royal College of Physicians and British Society of Rehabilitation Medicine. Rehabilitation following acquired brain injury: national clinical guidelines (Turner-Stokes L, ed). London: RCP, BSRM, viii

17 1 Introduction Occupational needs after brain injury 1.1 Return to employment is a major challenge after acquired brain injury, especially for those still in education, training or just establishing themselves in their chosen careers at the time of injury. Return to work or alternative meaningful occupation is a critical factor in the restoration of quality of life, but only a minority return to work after a severe brain injury. This has major economic implications as well as far-reaching personal and family consequences. 1.2 This is well illustrated in the case of head injury. Whilst subject to geographical variation, estimates of the overall annual incidence of hospital admission after head injury is 229 per 100,000 in England 178 per 100,000 for adults aged and 356 per 100,000 for children. 1 Around 8% of admissions would be expected to be unable to return to work at 6 months. However, if those requiring specialist assessment, advice and support to reduce avoidable vocational difficulties are also included, it is likely that at least double this number require some vocational input. A one-year follow-up of all admissions in and around Glasgow, for example, found that up to one-third of those employed at the time of injury may be unfit for work at oneyear follow-up. 2 Return to work is typically low (around 25 35%) both for severe traumatic brain injury 3 and for other neurological conditions such as epilepsy, 4 multiple sclerosis, 5 and stroke in young adults. 6 Many children with severe traumatic (and other brain injuries) will have difficulty in establishing themselves in employment on leaving school, 7 and may require specialist vocational assessment, advice and support. 1.3 If those who do return to work have not received expert advice, many return too soon or seek to resume full duties too quickly, resulting in fatigue, anxiety and depression which exacerbate the extent of difficulties. However, even with a managed return to work, reduced speed, poor concentration, unreliable memory, headaches and/or fatigue render many uncompetitive in the workplace. Other restrictions (eg seizures, physical/sensory deficits, executive/communication difficulties) may compromise a successful return to work, depending on the specific requirements of the job. For others, emotional vulnerability may reduce capacity to cope with pressure and/or responsibility, whilst irritability or overt expressions of frustration are likely to cause difficulties in relationships with colleagues. Disinhibited or aggressive behaviour is rarely tolerated in the workplace. Executive difficulties will also often limit both the client s awareness of these problems and the capacity to monitor and manage them effectively in the workplace. 1.4 Difficulties may arise months or years after a seemingly successful initial return to work, for example as a result of one or more of the following: build-up of fatigue or anxiety due to prolonged compensatory effort cognitive overload due to accumulation of new information introduction of new work duties or practices difficulty in adapting to change departure of familiar colleagues, supervisors or managers career progression involving increased demands. Others may cope with a return to a previous job but then struggle later when moving to a new job. Those seeking alternative employment tend to seek jobs consistent with pre-injury 1

18 Vocational assessment and rehabilitation after acquired brain injury qualifications, experience and aspirations, not taking full account of the vocational restrictions imposed by brain injury. Repeated work failure often drains self-confidence and belief, undermining both future attempts to return to work and overall adjustment. 1.5 For those unable to return to paid employment, positive outcomes can be achieved in the form of voluntary work or attendance at a sheltered workshop or other suitable occupational provision. However, input from brain injury services will often be required in exploring, liaising with and supporting appropriate placements. Whilst Headway, the brain injury association, or other voluntary agencies, may provide suitable occupational activities, their resources are limited and such services are not universally available. Clients with brain injury requiring occupational provision are therefore often referred to services set up for people with learning disabilities or mental health difficulties, which may not be appropriate for their needs. Others may enrol in further education courses but struggle without appropriate learning support. Background to Inter-Agency Advisory Group 1.6 In December 2002, the External Reference Group of the National Service Framework (NSF) for Long-Term Conditions was set up by the Department of Health. This focuses on long-term neurological conditions (including brain injury) for adults of working age. Vocational needs were among many issues identified in a scoping workshop in November 2001, with the need for vocational rehabilitation highlighted by both the Select Committee on Health report on Head injury: rehabilitation 8 and by the Neurological Alliance, 9 an umbrella group of voluntary organisations for people with neurological conditions. 1.7 In December 2002, the British Society of Rehabilitation Medicine (BSRM) set up a Working Party to develop national clinical guidelines on rehabilitation following acquired brain injury. 10 The Working Party wished to include guidelines on vocational rehabilitation. In view of the required joint working across the NHS, Jobcentre Plus, social services and independent providers, it was recommended to the Working Party that an inter-agency advisory group be set up to recommend vocational guidelines. (A previous BSRM Working Party reviewed vocational rehabilitation provision across all conditions and made general recommendations but did not address brain injury issues in detail. 11 ) 1.8 The first meeting of the Inter-Agency Advisory Group (IAAG) was held in April 2003 with representatives of NHS, Department of Work and Pensions/Jobcentre Plus, and both independent Work Preparation and WORKSTEP providers. Additional representation was later sought from the Department of Health (NHS Plus) and the Social Services Inspectorate, as well as a collegebased acquired brain injury programme (see Appendix 1A for Inter-Agency Advisory Group members). At this meeting it was agreed that there was a need for the Advisory Group to produce a joint framework and detailed guidelines for accessing currently available service provision, as well as recommending specific key guidelines to the BSRM Working Party. Rationale, aim and scope 1.9 Currently many people with brain injury receive no assistance in returning to past or alternative employment and fail to achieve their vocational potential. Given the benefit of specialist assessment and rehabilitation (see paras 2.4 9) there is an urgent need to ensure that clients both receive adequate core brain injury provision within the NHS and then have the opportunity to move on to specialist vocational provision. As a first step, there is a need for a 2

19 1 Introduction joint framework to guide brain injury services, Jobcentre Plus, social services and independent/ voluntary providers on appropriate and timely access to current provision for vocational assessment, work preparation, supported employment and alternative occupational provision. There is also a need for a review and recommendations about future provision of brain injury vocational rehabilitation including funding. However, the focus of this document is on the promotion of inter-agency working to facilitate appropriate and timely access to existing service provision The primary aim of the IAAG was to develop a joint framework and guidelines for accessing statutory provision for vocational assessment and rehabilitation after acquired brain injury across the NHS and Jobcentre Plus, including vocational services under contract in the independent sector. It is also essential to consider the needs of those returning to further education or vocational training. Brain injury services, Jobcentre Plus and social services therefore also need to work closely with local vocational training and further education colleges The framework seeks to enhance the prospects of successful return to employment or alternative occupation for the following subgroups: those seeking to return to previous work or training, with guidance and support those requiring assessment/support in seeking alternative employment/training those requiring a Work Preparation programme prior to return to work those requiring the WORKSTEP supported placement programme those requiring alternative occupational or educational provision The framework and guidelines for vocational assessment and rehabilitation will be set in the context of vocational outcome and service provision. Definitions 1.13 Definitions of some key terms used in this document are provided below. Brain injury 1.14 Acquired brain injury (ABI) is non-degenerative injury to the brain occurring since birth. This includes traumatic brain injuries, such as open or closed head injuries, or nontraumatic brain injuries, such as those caused by strokes and other vascular accidents, tumours, infectious diseases, metabolic disorders (eg liver and kidney diseases or diabetic coma), and toxic products taken into the body though inhalation or ingestion Traumatic brain injury (TBI) is Brain injury caused by trauma to the head including the effects of direct complications of trauma notably hypoxaemia, hypotension, intracranial haemorrhage and raised intracranial pressure. 13 (References to severity of traumatic brain injury in this document are in accordance with the definitions set out Appendix 2.) Brain injury rehabilitation 1.16 Brain injury rehabilitation conceptual definition: A process of active change through which a person who has become disabled after brain injury acquires the knowledge and skills needed for optimal physical, psychological and social function (adapted from Ref 13). 3

20 Vocational assessment and rehabilitation after acquired brain injury 1.17 Brain injury rehabilitation service definition: The use of all means to minimize the impact of disabling conditions and to assist disabled people to achieve their desired level of autonomy and participation in society Brain injury rehabilitation services: services employing staff who are trained to assess rehabilitation potential and needs, and to monitor and implement treatment, therapy and other elements of rehabilitation after brain injury (adapted from Ref 13). Vocational assessment/employment assessment 1.19 The terms vocational assessment and employment assessment are both used due to the specific meaning attached to employment assessment within Jobcentre Plus Vocational assessment has been defined as a global appraisal of an individual s work/training background, general functional capacities and social/behavioural characteristics. Vocational assessment can include an evaluation of medical factors, psychological makeup, educational background, social behaviours, attitudes, values, work skills and abilities Employment assessment (EA) addresses the job person interaction and seeks to enable individuals to predict their performance and needs in job opportunities. 15 EA is described as assisting unemployed jobseekers to make an informed decision about an appropriate and specific job. 16 This involves helping the jobseeker to acquire information about the job (eg roles, responsibilities, competencies, interpersonal skills etc) and assessing their potential to perform successfully in the job. The process of EA may involve a number of stages (eg interview, measurement, feedback, action planning) and tools (aptitude tests, work samples, job trials etc) each of which can differ in their predictive ability or quality of information obtained. 16 EA is not just concerned with whether an individual can perform the tasks required by the job, but also explores whether the individual is able to sustain employment and where appropriate, develop in the job. Vocational rehabilitation 1.22 Vocational rehabilitation: a broad term used to refer to the overall process of enabling individuals with either temporary or permanent disability to access, return to, or remain in, employment. 11 Government-funded programmes 1.23 The following government-funded employment programmes are outlined in the section on Jobcentre Plus services (paras ) (see also Access to Work (para 5.5) Job Introduction Scheme (para 5.6) Work Preparation (para 5.7) WORKSTEP (para 5.8) New Deal for Disabled People (NDDP) (para 5.9) Permitted Work (para 5.10) Linking Rules (para 5.11) 4

Vocational assessment and rehabilitation after acquired brain injury Inter-agency guidelines BSRM British Society of Rehabilitation Medicine Part of the Department for Work and Pensions Royal College of

Comments trom the Aberdeen City Joint Futures Brain Injury Group The Aberdeen City Joint Futures Brain Injury Group is made up of representatives from health (acute services, rehabilitation and community),

Vocational rehabilitation: specific needs and interventions Andy Tyerman Consultant Clinical Neuropsychologist On behalf of the Working Out Programme Community Head Injury Service, The Camborne Centre,

City University : February 2013 Vocational rehabilitation after traumatic brain injury Andy Tyerman Consultant Clinical Neuropsychologist / Head of Service Community Head Injury Service, Buckinghamshire

REHABILITATION MEDICINE by PROFESSOR ANTHONY WARD What is Rehabilitation Medicine? Rehabilitation Medicine (RM) is the medical specialty with rehabilitation as its primary strategy. It provides services

Guide To Best Practice At The Interface Between Rehabilitation And The Medico-Legal Process ISBN Number: 0-9540879-6-8. November 2006. To obtain further copies of this document please visit our website:

Neurorehabilitation Strategy Briefing Document and Position Paper Background What is neurorehabilitation? The World Health Organisation defines neurorehabilitation as: A problem-solving process in which

WHERE CAN PSYCHOLOGY TAKE ME? There are many careers in Psychology and many types of psychologist. If you are thinking of a career in Psychology, you need to go to university to study Psychology at undergraduate

Work Matters The College of Occupational Therapists Vocational Rehabilitation Strategy College of Occupational Therapists About the publisher The College of Occupational Therapists is a wholly owned subsidiary

Redford Court, Liverpool BIRT - the charity leading brain injury rehabilitation across the UK Registered Charity Nos. 800797-1 in England and Wales and SCO43579 in Scotland We aim to provide the best quality

The Regulation and Quality Improvement Authority Review of Brain Injury Services in Northern Ireland September 2015 Assurance, Challenge and Improvement in Health and Social Care www.rqia.org.uk The Regulation

Rehabilitation following acquired brain injury National clinical guidelines BSRM British Society of Rehabilitation Medicine Royal College of Physicians The guidelines were prepared by a multidisciplinary

Gainful Employment Information The Field of Counseling Job Outlook Veterans Administration one of the most honorable places to practice counseling is with the VA. Over recent years, the Veteran s Administration

Gainful Employment Information The Field of Counseling Job Outlook Veterans Administration one of the most honorable places to practice counseling is with the VA. Over recent years, the Veteran s Administration

Reconfiguration of Surgical, Accident and Emergency and Trauma Services in the UK K Reconfiguration of Surgical, Accident and Emergency and Trauma Services in the UK Summary Our aim is to provide an excellent

Stroke Helpline: 0303 3033 100 Website: stroke.org.uk Private treatment Because the NHS only offers limited access to some therapies after stroke, you might choose to explore the option of private treatment.

Valuing People VP Community Care Nationwide providers of specialist care and rehabilitation 9 YEARS OF SPECIALIST CARE VP Community Care An introduction to what we do Registered with the CQC, we support

BSRM Standards for Rehabilitation Services Mapped on to the National Service Framework for Long-Term Conditions British Society of Rehabilitation Medicine C/o Royal College of Physicians, 11 St Andrews

The new Stroke Nurse Practitioner candidate position at Austin Health The new Stroke Nurse Practitioner (NP) candidate position offered by Austin Health provides an exciting opportunity for a senior nurse

Performance Evaluation Report 2013 14 The City of Cardiff Council Social Services October 2014 This report sets out the key areas of progress and areas for improvement in The City of Cardiff Council Social

Pre-budget Submission 2016 Joint Committee on Finance, Public Expenditure and Reform July 2015 SUMMARY POINTS Acquired Brain Injury Ireland (ABI Ireland) is asking the Government to support people living

Making a pay claim if you work outside of the NHS Introduction The RCN recommends Agenda for Change (AfC) pay rates for all nursing staff wherever they may work. Where the RCN is recognised we will work

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE PUBLIC HEALTH PROGRAMME GUIDANCE DRAFT SCOPE 1 Guidance title Guidance for primary care services and employers on the management of long-term sickness

Exercise therapy and the treatment of mild or moderate depression in primary care Up and running? Executive summary Why isn t exercise referral offered by GPs? According to our research, only 42% of GPs

Policy for Preventing and Managing Critical Incident Stress Document reference number HSAG 2012/3 Document developed by Revision number 1.0 Document approved by Consultation with 14 September 2012 Presented

Creating A Healthy Workplace Source: Mental Health In the Workplace: Tackling the Effects of Stress booklet Published by the Mental Health Foundation, London (UK) Any employer who wishes to create a healthy

Care Programme Approach (CPA) The Care Programme Approach (CPA) is used to plan many people s mental health care. This factsheet explains what it is, when you should get and when it might stop. The Care

Goole Neuro-Rehabilitation Centre We aim to provide the best quality neurobehavioural rehabilitation for people with complex and challenging needs after brain injury. Ultimately, we want to enable service

Human Behavioural Guidance Version No: 0.1 Purpose of this document This document comprises the Human Behavioural Guidance for NHS Organisations in relation to the changes to the Main Specialty and Treatment

Selection Policy 2014: Introduction University of Surrey PsychD Clinical Psychology Programme The Surrey PsychD Programme in Clinical Psychology is aware of the importance of recruiting and selecting high

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Guideline scope Workplace health: support for employees with disabilities and long-term conditions Short title Workplace health: employees with disabilities

Re-assessing career pathways after Brain Injury The Cedar Foundation Brain Injury Services Vocational Rehabilitation Service Targets people with complex disabilities as a result of brain injury. Flexible,

Developments in nurse education in England Summary BSMHFT employs 1319 registered nurses and 641 health care assistants 53% of the total workforce. BSMHFT works in partnership with Birmingham City University

EARLY INTERVENTION AND PREVENTION STRATEGY 2012-15 Summary Plymouth Children, Young People and Families Partnership INTRODUCTION Why do we need early intervention in Plymouth? We know that effective early

Rehabilitation of employees back to work after illness or injury Policy and Procedure Document reference number HSAG 2011/3 Document developed by Revision number 4.13 Document approved by Approval date

Clinical Access and Redesign Unit Health Professionals who Support People Living with Dementia (in alphabetical order) Health Professional Description Role in care of people with dementia Dieticians and

SERVICE SPECIFICATION FOR: Dual Diagnosis Mental Health and Substance Misuse Supported Housing Service The specification describes the Service to be delivered under the Steady State Contract for Provision

Traumatic brain injury EMOTIONAL AND BEHAVIOURAL CONSEQUENCES OF HEAD INJURY Traumatic brain injury (TBI) is a common neurological condition that can have significant emotional and cognitive consequences.

Information for Adults with Physical Disabilities and Long Term Neurological Conditions Rehabilitation Medicine Service Community & Therapy Services Directorate of Operations This leaflet has been designed

THE PSYCHOLOGICAL SOCIETY OF IRELAND CUMANN SÍCEOLAITHE ÉIREANN GUIDELINES FOR THE ASSESSMENT OF POSTGRADUATE PROFESSIONAL PROGRAMMES IN CLINICAL PSYCHOLOGY DATE: 31 ST OF JANUARY 2009 1 TABLE OF CONTENTS

OCCUPATIONAL GROUP: Social Services CLASS FAMILY: Social Work CLASS FAMILY DESCRIPTION: This family of positions includes those whose purpose is to provide social services to various populations, including

Skill Levels for Delivering High Quality Asthma and COPD Respiratory Care by Nurses in Primary Care September 2007 Revised December 2009, April 2014 Author: Ruth McArthur In conjunction with the PCRS-UK

24 February 2015 Council 5 To consider Human Resources Report 2014 and People Strategy Issue 1 The annual report on Human Resources issues and a proposed People Strategy. Recommendations 2 Council is asked

Momentum Skills North East Services for Acquired Brain Injury and Neurological Conditions Who is the service for? Momentum Skills North East caters for individuals who wish to re-engage with their local

The Way Forward: Strategic clinical networks The Way Forward Strategic clinical networks First published: 26 July 2012 Prepared by NHS Commissioning Board, a special health authority Contents Foreword...

REHABILITATION IN PERSONAL INJURY CLAIMS By Carol Jackson Principal Lawyer Pannone Part of Slater & Gordon Rehabilitation It s not all about the money There is more a solicitor can do Increasing and proper

PAPER 1 THE SCHOOL COUNSELLING WORKFORCE IN NSW GOVERNMENT SCHOOLS Introduction This paper describes the current school counselling service within the Department of Education and Communities (the Department)

Job Description POSITION: PHYSICIAN RESPONSIBLE TO: CLINICAL DIRECTOR, MEDICAL SERVICES PRINCIPAL OBJECTIVES: 1. To provide medical services to the community served by the South Canterbury District Health